Healthcare Provider Details

I. General information

NPI: 1417068214
Provider Name (Legal Business Name): RUPERT BARRON JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 NE 7TH
AMARILLO TX
79101
US

IV. Provider business mailing address

1400 WALLACE BLVD ATTN CREDENTIALING
AMARILLO TX
79106
US

V. Phone/Fax

Practice location:
  • Phone: 806-374-9964
  • Fax: 806-374-2945
Mailing address:
  • Phone: 806-354-5585
  • Fax: 806-354-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8250
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: